Integration of monitoring technology for heart failure.

PURPOSE OF REVIEW

Death and hospitalization for acutely decompensated heart failure are predominantly due to volume overload, have increased in the past 10 years, carry poor outcomes, and are costly to the healthcare system. Clinical monitoring with daily weight and symptoms is relatively insensitive for early detection of volume overload. This lack of diagnostic accuracy has led to the development of technologies as an aid for early detection of clinical decompensation.

RECENT FINDINGS

Multidisciplinary heart failure clinics are currently the standard of care; however, recent large randomized studies have failed to show benefits in comparison to usual care when follow-up is frequent. Technologies, such as intrathoracic impedance monitoring incorporated into implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices, have shown variable sensitivity and low positive predictive value in predicting heart failure hospitalizations. As such, they have yet to consistently show efficacy in reducing hospitalizations for heart failure. Implantable hemodynamic monitoring devices have shown promise in reducing hospitalization rates for acutely decompensated heart failure, over and above heart failure clinic care. However, these studies were performed on younger populations with relatively few noncardiac comorbidities and have not been studied in the typical elderly heart failure patient populations.

SUMMARY

The ability to acquire hemodynamic data with the help of implanted devices can provide early warning of heart failure decompensation and thus may aid in preventing hospitalizations for heart failure. Further studies will clarify patient populations most likely to benefit from this intervention.